80mmHg in all patients at stimulating test. Selected septal branch angiography was taken. The methods of target septal branch selection included balloon occlusion test, angiography through the catheter lumen, and ultrasonic echocardiogram monitor. The 1st septal branch was ablated in 6 patients, and in 2nd branch in 2. The volume of alcohol injected was 1 75~7 0ml. The results showed that the successful rate of PTSMA operation was 100%, and the clinical symptoms for all patients improved significantly with mean LVOTPG decreased by 68 3%?13 0% at the end of the procedure. No severe ventricular arrhythmia occurred. One patient was followed-up clinically and angiographically half a year after the operation and his LVOTPG was 0 mmHg and the NYHA heart function was raised to Ⅱ grade from Ⅳ grades before operation. PTSMA is a promising interventional technique for HOCM therapy with satisfactory short-term clinical outcome.

OBJECTIVE:To explore mechanism,prevention and treatment of thrombosis following implantation of coronary artery stent.METHODS:The first author used computer to retrieve Vip Database (http://www.cqvip.com/) for articles concerning thrombosis following implantation of coronary artery stent published from January 2000 to October 2009.The key words included "coronary artery,stent implantation,thrombus".The data were primarily screened,and references of each article were checked.Inclusion criteria:mechanism and risk factor of thrombosis in stent;prevention and treatment of thrombosis in stent.Exclusion criteria:articles addressing duplicated or old contents.Finally,28 articles were included.RESULTS:Thrombosis in stent was a severe complication in interventional therapy of coronary artery disease,could induce severe outcomes for the body.Compared with common mental stent,drug eluting stents can significantly reduce restenosis rate and revascularization rate of target lesions.Following stent implantation,thrombosis in stent can occur in early,late and extremely late phases.The mechanisms are different.Antiplatelet,anticoagulation and lipid-lowering therapy can diminish the occurrence rate of thrombosis in stent.Individual surgery and individual drug therapy not only can solve revascularization in the coronary artery,but also decrease restenosis rate and occurrence rate of thrombosis in stent.CONCLUSION:With the expectation of novel stents,various risk factors for thrombosis in stent should be assessed in detail to achieve individual surgery and individual drug therapy.During revascularization in the coronary artery,restenosis rate and occurrence rate of thrombosis in stent should be reduced.

Objective To analyze the trends and status of percutaneous coronary intervention(PCI)in Shenyang General Hospital of P.L.A.during a 18-year period.Methods Between August 1989 and April 2007,a total of 10 225 patients with 17762 target lesions had undergone PCI.Their clinical and angiographic baseline characteristics,PCI strategies and perioperative outcomes were retrospectively analyzed.All data were collected from PCI database of our hospital.Results Patients' age ranged from 22 to 92 years old(mean,59.9 years).A total of 2057 patients(20.2%)were with diabete,8647(84.6%)with acute coronary syndromes,1428(14.0%)with acute myocardial infarction(AMI)and underwent emergent PCI,477(4.7%)with cardiogenic shock;6701(65.5%)with multivessel disease,483(4.7%)with left main disease and 1795(17.2%)with chronic total occlusions(CTO).Overall patient success rate was 98.5% and lesion success rate was 98.3%.Procedural success was obtained in 99.6% of patients with left main disease and 90.5% of CTO lesions.About 89.8% of all patients underwent coronary stenting.Mean implanted stent number was 1.45 per patient.In-hospital mortality was 4.4%(63/1428)for AMI patients who underwent emergent PCI and 19.7%(42/213)for AMI patients with cardiogenic shock.Overall perioperative mortality was 1.1%(113/10 225),including 2 deaths during procedure(0.02%)and 80(0.8%)deaths after procedure.Two patients(0.02%)underwent emergent CABG.Acute or subacute stent thrombosis occurred in 58 patients(0.57%)and slow flow or no-reflow occurred in 127 patients,which accounted for 8.9% of AMI patients who underwent emergent PCI.Overall incidence of perioperative complications was 3.6% and the rate of procedure related complications was 0.48%.Conclusion In skilled cardiac center,PCI is associated with high procedural success rate,low incidence of complications and good short-term outcomes.PCI should be the first choice for treating patients with coronary artery disease,especially for high risk patients with AMI,cardiogenic shock or left main disease,etc.

Objective To explore the feasibility and efficacy of an optimized antiplatelet therapy according to laboratory test after coronary stenting.Methods Between June 2006 and February 2007,a total of 305 patients who underwent coronary stenting in General Hospital of Shenyang Command were enrolled.Patients were randomly assigned to receive optimized(optimal group,n=154)or standard antiplatelet therapy(standard group,n=151).Clopidogrel resistance(CR)was defined as a less than 10% reduction of platelet aggregation at 24h after clopidogrel treatment.The antiplatelet regimen for standard group was dual antiplatelet therapy with aspirin and clopidogrel.In optimal group,CR patients received cilostazol for 6 months in addition to dual anitplatelet therapy,whereas non-CR patients received standard dual antiplatelet therapy.The primary endpoint of present study was the composite analysis of death,myocardial infarction(MI)or stroke.Secondary endpoint was the composite analysis of death,MI,stroke,revascularization or peripheral artery occlusion.Results There were 41 and 33 CR patients in optimal and standard group,respectively.Cilostazol in addition to dual antiplatelet therapy decreased significantly the PAR of CR patients in optimal group(77.5%?12.1% vs 64.5%?12.1%,P

Vasovagal reflex is one of complications from cardiac intervention.The major causes of vasovagal reflex postprocedure are commonly believed to be associated with mental stress,pain,low blood volume,visceral dilation,local hematoma and cardiac function.The incidence of vasovagal reflex may be effectively reduced with standard intervention training,strictly selected indications for PCI,adequate fluid replacement after procedure,anesthetic lidocaine to reduce pain,improved manual compression for vascular hemostasis and elimination of risk factors.

Objective To assess the outcome of renal artery stenosis approached by percutaneous transluminal renal angioplasty (PTRA) and stents.Methods Seventy-two patients (50 males and 22 female) were diagnosed as renal stenosis by renal angiography.Of them,68 cases were with atherosclerosis.The PTRA was done via femoral access site.Changes in blood vessel diameter and blood flow nd complications were recorded.Renal angiograph was performed to check the restenosis.Patient’s blood pressure and serum creatine level before and after the were observed.Results Angiograph showed unilateral artery lesion in 60 cases and bilateral stenosis in 12 cases.The ostium was involved in 72 sites and mid-part in 8.The lumen diameter of stenosis was 60%-95%.The stents were successfully implanted in 68 cases with 78 stents and 4 cases only by balloon.The lumen diameter of lesion increased from 2.0mm (0.8-2.6mm) to 6.5mm (4.0-8.0mm).TIMI flow decreased in 3 cases and renal function was impaired in 4 cases,but not severe.Blood pressure in 42 cases with hypertension decreased significantly.One case was complicated with perirenal hematoma.and there was no perioperative death.Conclusion PTRA and stenting treatment for renal artery disease are feasible and safe.

60 years old with coronary artery disease in hospital from Jan.2002 to Aug 2004 who accepted coronary intervention.They were divided into Tansradial group(TRA,n=382) and Transfemoral group(TRF,n=382).The success rate and time of puncture,x-ray exposure time,procedure duration,dose of dye,complication in puncture site and pulmonary embolism were observed in the two groups.Results 368 out of 382 cases success in TRA group and 372 cases in TRF group.The success rate was not different.The success rate of puncture,x-ray exposure time,procedure duration and dose of dye had no difference between the two groups.But the complication in puncture site and pulmonary embolism were more in TRF group than in TRA group.The coronary intravascular ultrasound and cutting balloon technique were successfully done in two groups.The mean in-hospital time was less in TRA group (2.1?0.6 days) than in TRF group (4.2?1.6days,P

Objective To compare the short-term efficiency and safety of high loading dose (600 mg) clopidogreal pretreatment with that of routine loading dose (300 mg) before coronary stenting in patients with acute coronary syndromes (ACS). Methods Prospective registry method was used in this study. Between February 2003 to July 2004, a total number of 316 hospitalized patients with ACS received 600 mg clopidogrel pretreatment, before coronary stenting. 309 patients with the same disease conditions who received 300 mg clopidogrel pretreatment between October 2001 to January 2003 were included as the control. The primary endpoints were the presence of subacute in-stent thrombosis. 30 days after the procedure. The composite endpoints were death of all causes, myocardial infraction and revascularization of the target ressel. The secondary endpoint was hemorrhagic events at 30 days after the stenting procedure. Results The baseline clinical and angiographic characteristics and the result of stenting between the two groups had no significants difference. Rate of subacute in-stent thrombosis was significantly lower in 600 mg group than that of 300 mg group (0.0% vs 2.6%, P=0.003). An interval of

Objectives\ To analyse the development of coronary intervention in our heart center of a general hospital in recent 13 years.Methods\ Coronary interventions were performed in 3945 target lesions of 2466 patients with coronary heart disease who were from 22 to 86 years old(averaged 58 8 yrs)with 80 5% of male,including 335 cases of acute myocardial infarction,64 cardiogenic shock,2106 acute coronary syndrome,1329 multivessel disease,and 21 left main disease.The proportion of complicated B2 and C type lesions were 77 1% and chronic total occlusion were 21 4%,PTCA and stenting were the main intervention operation(97 4%),and rotation,direct atherectomy,cutting,intravascular radiation and cover stenting were also perfromed for the remaining 2 6% patients.Results\ The mean annual case increase rate was 61 2% from 1995 to 2001 The toltal patient and lesion success rates were 98 1% and 97 1%,respectively.The mortality during intervention were 0 08% and for cardiogenic shock were 28 1% during hospitalization.Conclusions\ The data suggest that the success rate and incidence of complications for coronary intervention in the heart center with well-dereloped technigues are comparable with those reported in foreign literatures.

Objectives To evaluate the safety and effect of transradial approach for coronary intervention. Methods A total of 165 cases of coronary artery disease in this hospital accepted coronary intervention by transradial approach. Three of them had acute myocardial infarction, 112 had unstable angina, and 67 failed by transfemoral approach. Results The proportion of multivessel diseases were 60 6% and C type lesions were 20 7%. The interventons were performed in totally 294 target vessels and 299 target lesions and 246 stents were implanted. Coronary intravescular ultrasound were performed in 14 cases and cutting balloon technique in 16 cases. During intervention 1 case had right coronary spiral dissection and was successfully treated by stenting. One case had subacute thrombosis after intervention and was successfully treated by re-intervention. There were no other severe complications in this group. The mean hospital stay was (2 1?0 6) days. The total success rate was 98 2%(162/165) for transradial approach. The interventions in two cases who had chronic total occlusion in circumflex artery failed by transradial but succeeded by transfemoral thereafter .Conclusions Transradial approach for coronary intervention is a safe and effective approach so long as standardized manipulation is practised.